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# Diclofenac (Oral)
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.
## Primary Indications
* Osteoarthritis
* Rheumatoid arthritis
* Ankylosing spondylitis
* Acute pain
* Primary dysmenorrhea
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg orally two to three times daily, or 75 mg orally twice daily. Maximum daily dose: 150 mg.
* **Acute Pain:** Initial dose: 50 mg orally, followed by 50 mg every 8 hours as needed. Alternatively, 75 mg orally twice daily. Do not exceed 150 mg in 24 hours.
* **Primary Dysmenorrhea:** Initial dose: 50 mg orally, followed by 50 mg three times daily as needed. Maximum daily dose: 200 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well established. Use should be based on clinical judgment and physician guidance.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. May require dose reduction in patients with mild to moderate hepatic impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function closely. Consider dose reduction in mild to moderate renal impairment. Avoid in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Abdominal pain, nausea, dyspepsia, diarrhea, constipation, headache, dizziness.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic injury, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Decreased antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Baseline and periodic:** Renal function (serum creatinine, BUN), liver function (ALT, AST), complete blood count (CBC), electrolytes.
* **Monitor for signs/symptoms of:** GI bleeding, cardiovascular events, renal toxicity, hepatic toxicity, hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Be aware of the black box warning regarding cardiovascular and GI risks.
* Concurrent use with other NSAIDs or aspirin increases the risk of adverse effects.
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This information is intended for healthcare professionals. Please consult the official prescribing information and your institution's protocols for complete details and to ensure current accuracy before making any clinical decisions.
